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RE: [FH] Alternatives to Atenolol?

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  • Jennifer Trendler
    I would recommend taking him off. My cardio told me when Chase started taking Atenol last year to watch him for ANY side effects. Atenol is an interesting
    Message 1 of 5 , Oct 1, 2003
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      I would recommend taking him off.

      My cardio told me when Chase started taking Atenol last year to watch him
      for ANY side effects. Atenol is an interesting drug.

      last year Chase was taking that with something else (I can't recall the
      exact name) and he did the same thing. Lost appetite, glassy eyed, little
      response. I took him to the vet and his liver was sky high. This means
      that the drugs were interacting and causing Liver Toxicity (which can be
      fatal).

      Now - he is back on Atenol, BUT with no other med and only a quarter tablet
      1X daily. Cardio said that I could work up to a half tab, but if I felt
      more comfortable or Chase was more comfortable on a 1/4 keep him there.
      Every pet responds differently to meds.

      I decided to keep him on a 1/4 tab, because he responded beautifully and
      moves around and lowers his appetite (which I'm glad for - he's a mouth
      (18lbs.)). however, I do notice that some days he just doesn't feel as
      great. So - I think 1/4 is perfect.

      good luck!

      -----Original Message-----
      From: pugsleykall [mailto:lgowk@...]
      Sent: Tuesday, September 30, 2003 6:37 PM
      To: feline-heart@yahoogroups.com
      Subject: [FH] Alternatives to Atenolol?


      My cat has been taking 6.25 mg of Atenolol for 2 weeks, and is doing
      horribly on it. I feel like I'm giving him chemo for how sick it
      makes him. Prior to being diagnosed with HCM, his symptoms were
      continuing weight loss and poor appetite. The drug completely cuts
      out his appetite, he has lost another pound, down to 8 pounds, from
      12, and even though the cardiologist told me I could cut the medicine
      to every other day if it affected his appetite, it's taking longer
      than 2 days for him to start eating again.

      Does this sound "normal" to you? For the past day, he's holding his
      body very rigid, not purring, and almost in a catatonic state. Won't
      eat, drink, anything.

      Should I approach my vet about some other drug, or should we plod
      ahead on this one? I feel like he's better off without it, come what
      may. It's unbearable to see him this sick.

      Thanks for any advice.
      Lisa



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    • Susan
      ... Never discontinue beta-blockade suddenly. From the Plumb Handbook of Veterinaty Drugs: Contraindications/Precautions/Reproductive Safety Atenolol is
      Message 2 of 5 , Oct 1, 2003
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        --- Jennifer Trendler <jennifert@...>
        wrote:
        > I would recommend taking him off.

        Never discontinue beta-blockade suddenly.

        From the Plumb Handbook of Veterinaty Drugs:

        Contraindications/Precautions/Reproductive Safety

        Atenolol is contraindicated in patients with overt
        heart failure, hypersensitivity to this class of
        agents, greater than first degree heart block, or
        sinus bradycardia. Non-specific beta-blockers are
        generally contraindicated in patients with CHF unless
        secondary to a tachyarrhythmia responsive to
        beta-blocker therapy.

        (NOTE: based on human CHF trials this is no longer
        true. See below for complete reference.)

        They are also relatively
        contraindicated in patients with bronchospastic lung
        disease.

        Atenolol should be used cautiously in patients with
        significant renal insufficiency. It should also be
        used cautiously in patients with sinus node
        dysfunction.

        Atenolol (at high dosages) can mask the symptoms
        associated with hypoglycemia. It can also cause
        hypoglycemia or hyperglycemia and, therefore, should
        be used cautiously in labile diabetic patients.

        Atenolol can mask the symptoms associated with
        thyrotoxicosis, but it may be used clinically to treat
        the symptoms associated with this
        condition.

        Adverse Effects/Warnings

        It is reported that adverse effects most commonly
        occur in geriatric animals or those that have acute
        decompensating heart disease. Adverse effects
        considered to be clinically relevant include:
        bradycardia, lethargy and depression, impaired AV
        conduction, CHF or worsening of heart failure,
        hypotension, hypoglycemia, and bronchoconstriction
        (less so with beta1 specific drugs like
        atenolol). Syncope and diarrhea have also been
        reported in canine patients with beta blockers.
        Lethargy and hypotension may be noted
        within 1 hour of administration.

        Exacerbation of symptoms have been reported following
        abrupt cessation of beta-blockers in humans. It is
        recommended to withdraw therapy gradually in patients
        who have been receiving the drug chronically.

        From:
        Management of Feline Cardiomyopathies
        http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2991

        "Neurohormonal activation plays an important role in
        heart failure. Thus, disruption of neurohormonal
        activation represents therapeutic rationale for using
        ACE inhibitors. The RAS plays a prominent role in
        human HCM patients by influencing or regulating the
        expression of myocardial hypertrophy. Inhibition of
        RAS has a beneficial effect on extracellular
        remodeling in CHF, and ACE inhibitors reduce
        ventricular remodeling by blocking the tropic effects
        of angiotensin II on myocytes. There is also survival
        value provided by early use of ACE inhibitors in acute
        human myocardial infarction. Many clinicians combine
        an ACE inhibitor (usually enalapril) with furosemide,
        with or without a beta-blocker or diltiazem,
        particularly with recurrent heart failure. Enalapril
        (0.25-0.5 mg/kg q24h PO) and benazepril (0.25-0.5
        mg/kg q24h PO) are clinically well tolerated. Optimal
        timing for ACE inhibitor therapy and the effects of
        these agents on morbidity and mortality in feline
        cardiomyopathy is undetermined."


        From a question I asked on the vetlearning.com forum:

        I asked the following question on the bulletin board
        on vetlearn.com:

        is there a downside to atenolol?
        my question:
        I have read Kittleson, Fox, Fuentes, Bonagura and
        Nelson and I realize there is no proof that there is
        any advantage to medicating asymptomatic HCM felines,
        however my vet does believe in doing so based on his
        own personal experience. Clinically I believe I have
        seen a difference and certain ultrasound paramaters
        are improved. However according to Plumb's Handbook of
        Veterinary Drugs, CHF is listed as an adverse effect.
        Is this more likely referring to propanol rather than
        atenolol?

        Re:
        Submitted Thursday July 10, 2003 - 8:19:31pm by Alex,
        DVM
        Reply
        I've not seen any cases of CHF that I felt were due
        to atenolol. The referance may have been to propanolol
        since it is a non-selective beta-blocker.

        Susan (Rudy is on 12.5 mg atenolol for 1 year now)

        >
        > My cat has been taking 6.25 mg of Atenolol for 2
        > weeks, and is doing
        > horribly on it. I feel like I'm giving him chemo
        > for how sick it
        > makes him. Prior to being diagnosed with HCM, his
        > symptoms were
        > continuing weight loss and poor appetite. The drug
        > completely cuts
        > out his appetite, he has lost another pound, down to
        > 8 pounds, from
        > 12, and even though the cardiologist told me I could
        > cut the medicine
        > to every other day if it affected his appetite, it's
        > taking longer
        > than 2 days for him to start eating again.
        >
        > Does this sound "normal" to you? For the past day,
        > he's holding his
        > body very rigid, not purring, and almost in a
        > catatonic state. Won't
        > eat, drink, anything.

        >
        > Should I approach my vet about some other drug, or
        > should we plod
        > ahead on this one? I feel like he's better off
        > without it, come what
        > may. It's unbearable to see him this sick.
        >
        > Thanks for any advice.
        > Lisa
        >
        >

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      • Jennifer Trendler
        Well - don t know what to say. I saw Chase the way he was - and was told to take him off completely and suddenly. It worked and now he s fine. ... From: Susan
        Message 3 of 5 , Oct 1, 2003
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          Well - don't know what to say. I saw Chase the way he was - and was told to
          take him off completely and suddenly.

          It worked and now he's fine.

          -----Original Message-----
          From: Susan [mailto:somnamblst@...]
          Sent: Wednesday, October 01, 2003 6:48 AM
          To: Jennifer Trendler; 'pugsleykall'
          Cc: 'feline-heart@yahoogroups.com'
          Subject: RE: [FH] Alternatives to Atenolol?



          --- Jennifer Trendler <jennifert@...>
          wrote:
          > I would recommend taking him off.

          Never discontinue beta-blockade suddenly.

          From the Plumb Handbook of Veterinaty Drugs:

          Contraindications/Precautions/Reproductive Safety

          Atenolol is contraindicated in patients with overt
          heart failure, hypersensitivity to this class of
          agents, greater than first degree heart block, or
          sinus bradycardia. Non-specific beta-blockers are
          generally contraindicated in patients with CHF unless
          secondary to a tachyarrhythmia responsive to
          beta-blocker therapy.

          (NOTE: based on human CHF trials this is no longer
          true. See below for complete reference.)

          They are also relatively
          contraindicated in patients with bronchospastic lung
          disease.

          Atenolol should be used cautiously in patients with
          significant renal insufficiency. It should also be
          used cautiously in patients with sinus node
          dysfunction.

          Atenolol (at high dosages) can mask the symptoms
          associated with hypoglycemia. It can also cause
          hypoglycemia or hyperglycemia and, therefore, should
          be used cautiously in labile diabetic patients.

          Atenolol can mask the symptoms associated with
          thyrotoxicosis, but it may be used clinically to treat
          the symptoms associated with this
          condition.

          Adverse Effects/Warnings

          It is reported that adverse effects most commonly
          occur in geriatric animals or those that have acute decompensating heart
          disease. Adverse effects considered to be clinically relevant include:
          bradycardia, lethargy and depression, impaired AV
          conduction, CHF or worsening of heart failure,
          hypotension, hypoglycemia, and bronchoconstriction
          (less so with beta1 specific drugs like
          atenolol). Syncope and diarrhea have also been
          reported in canine patients with beta blockers.
          Lethargy and hypotension may be noted
          within 1 hour of administration.

          Exacerbation of symptoms have been reported following
          abrupt cessation of beta-blockers in humans. It is
          recommended to withdraw therapy gradually in patients
          who have been receiving the drug chronically.

          From:
          Management of Feline Cardiomyopathies
          http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2991

          "Neurohormonal activation plays an important role in
          heart failure. Thus, disruption of neurohormonal
          activation represents therapeutic rationale for using
          ACE inhibitors. The RAS plays a prominent role in
          human HCM patients by influencing or regulating the
          expression of myocardial hypertrophy. Inhibition of
          RAS has a beneficial effect on extracellular
          remodeling in CHF, and ACE inhibitors reduce
          ventricular remodeling by blocking the tropic effects
          of angiotensin II on myocytes. There is also survival
          value provided by early use of ACE inhibitors in acute
          human myocardial infarction. Many clinicians combine
          an ACE inhibitor (usually enalapril) with furosemide,
          with or without a beta-blocker or diltiazem,
          particularly with recurrent heart failure. Enalapril
          (0.25-0.5 mg/kg q24h PO) and benazepril (0.25-0.5
          mg/kg q24h PO) are clinically well tolerated. Optimal
          timing for ACE inhibitor therapy and the effects of
          these agents on morbidity and mortality in feline cardiomyopathy is
          undetermined."


          From a question I asked on the vetlearning.com forum:

          I asked the following question on the bulletin board
          on vetlearn.com:

          is there a downside to atenolol?
          my question:
          I have read Kittleson, Fox, Fuentes, Bonagura and
          Nelson and I realize there is no proof that there is
          any advantage to medicating asymptomatic HCM felines,
          however my vet does believe in doing so based on his
          own personal experience. Clinically I believe I have
          seen a difference and certain ultrasound paramaters
          are improved. However according to Plumb's Handbook of Veterinary Drugs, CHF
          is listed as an adverse effect. Is this more likely referring to propanol
          rather than atenolol?

          Re:
          Submitted Thursday July 10, 2003 - 8:19:31pm by Alex,
          DVM
          Reply
          I've not seen any cases of CHF that I felt were due
          to atenolol. The referance may have been to propanolol
          since it is a non-selective beta-blocker.

          Susan (Rudy is on 12.5 mg atenolol for 1 year now)

          >
          > My cat has been taking 6.25 mg of Atenolol for 2
          > weeks, and is doing
          > horribly on it. I feel like I'm giving him chemo
          > for how sick it
          > makes him. Prior to being diagnosed with HCM, his
          > symptoms were
          > continuing weight loss and poor appetite. The drug
          > completely cuts
          > out his appetite, he has lost another pound, down to
          > 8 pounds, from
          > 12, and even though the cardiologist told me I could
          > cut the medicine
          > to every other day if it affected his appetite, it's
          > taking longer
          > than 2 days for him to start eating again.
          >
          > Does this sound "normal" to you? For the past day,
          > he's holding his
          > body very rigid, not purring, and almost in a
          > catatonic state. Won't
          > eat, drink, anything.

          >
          > Should I approach my vet about some other drug, or
          > should we plod
          > ahead on this one? I feel like he's better off
          > without it, come what
          > may. It's unbearable to see him this sick.
          >
          > Thanks for any advice.
          > Lisa
          >
          >

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          The New Yahoo! Shopping - with improved product search
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        • brinkett
          The key point is that you were told by the vet to take him off. The original poster should consult with her vet and/or cardiologist and follow their
          Message 4 of 5 , Oct 1, 2003
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            The key point is that you were told by the vet to take him off. The
            original poster should consult with her vet and/or cardiologist and
            follow their recommendations.

            This is a great place to share experiences and knowledge, but one
            thing we shouldn't do is tell someone to change their cat's
            medication regimen. This should only be done in consultation with
            their vet. The best we can do is relate our experiences with a
            medication, which I think is extremely helpful, and then suggest
            that the person consult with their vet about the medications that
            their cat is on if they are having concerns or doubts about it.

            Hopefully your post about your experience with atenolol will prompt
            the original poster to speak to her vet about whether atenolol is
            making her cat ill. However, she should not discontinue the
            atenolol or make any other changes to her cat's medication unless
            instructed to do so by her vet.

            --- In feline-heart@yahoogroups.com, Jennifer Trendler
            <jennifert@n...> wrote:
            > Well - don't know what to say. I saw Chase the way he was - and
            was told to
            > take him off completely and suddenly.
            >
            > It worked and now he's fine.
            >
          • Susan
            ... I agree. We need to realize that HCM is just a catchall term for an extremely variable disease. I posted the info from Plumb s Book of Veterinary Drugs
            Message 5 of 5 , Oct 1, 2003
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              --- brinkett <scrubbrush@...> wrote:
              > The key point is that you were told by the vet to
              > take him off. The
              > original poster should consult with her vet and/or
              > cardiologist and
              > follow their recommendations.
              >


              I agree. We need to realize that HCM is just a
              catchall term for an extremely variable disease. I
              posted the info from Plumb's Book of Veterinary Drugs
              because not every symptom being attributed to
              beta-blockade is necessarily a result of
              beta-blockade. Sometimes things that we think are
              related are simply a coincidence. Anorexia and
              lethargy are symptoms of the disease and may have more
              to do with decompensation. No one here is in a
              position to recommend any mode of treatment or
              discontinuation of treatment. If you think your vet
              may be wrong seek out another board certified ACVIM
              veternarian. And always report any new symptoms to
              your vet cardiologist or internist. JMHO.

              Susan

              =====
              Rudy: Male DSH brown tabby, feral mom, diagnosed 09-2002 at 19 months of age with idiopathic HCM: grade 2 murmur, hyperkinetic heart, borderline normal thickening, considered asymptomatic, 12.5 mg Atenolol 1x day, 1/2 baby aspirin 2x week administered via pilling

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